Thursday, July 7, 2011

Since my wife and I had our baby boy Finley just three weeks ago I'm taking a couple months off from traveling to Haiti. However, I'm still working hard from home and wanted to share a great article I came across today.

It's about one of Direct Relief's largest recipients of aid since the quake. They are basically the only full-scale trauma and surgical hospital, have one of the only neo-natal ICUs, and now have one of the only CT scanners in the country. They also have a full-scale prosthetics/orthotics fabrication center on-site and are in the process of building a teaching hospital on-site. They provide free care to everyone who walks in and now are able to perform surgeries for hundreds of hydrocephalus children (which are by far the hardest thing for me to see) thanks to the CT scanner and rotating teams of neurosurgeons.

The article states that this model needs to be replicated throughout Haiti--and it's true. What they don't mention is that a great organization called Project Medishare is spending around $200,000 per month to keep it running and unfortunately that will likely not be able to continue forever. Running a hospital in Haiti (or anywhere) for a population of people who cannot pay is about the most expensive undertaking there is.

Nonetheless, this place is doing amazing work--not only in the immediate aftermath of the quake, but even now 19 months on.

Thursday, June 2, 2011

We arrived at the small medical clinic in Petit Trou de Nippes about five hours after we left Port au Prince that morning. The distance is only 75 miles but the unpaved roads, traffic, and small lakes and rivers we had to drive through to get there made the drive take quite a while. Halfway through the trip my Haitian colleague Catherine asked me if I felt like I was in a blender due to the jostling of the Land Cruiser we were driving in. We just pretended we were getting expensive lower back massages the whole way.

Like the other clinics I’ve visited on this trip, this is the only one serving the 25,000 people who live in the area. Unfortunately, this one currently does not have a doctor because he left for a training course in Port au Prince and they fear he’s not coming back due to the poor pay he’s receiving working at the small government clinic. So it’s currently being run by an extremely young but committed first year resident who just graduated from medical school last year. I asked her if she felt ready to be running a medical clinic just one year out of school. Before she answered yes, she hesitated and looked around at the two nurses, social worker, administrator, pharmacist, and lab technician who were sitting on the bench across from her waiting to hear what she’d say. It seemed like she wanted to reassure them that she could do it.

Like the doctor on the island of La Tortue who asked for a better boat to get his patients across the ocean to the larger hospital, the doctor at this clinic also asked for better transport. However, she wasn’t asking for it so she could send patients to other facilities, she was asking for it so they could have a way to get women into her clinic to deliver their babies. The only “ambulance” the clinic has is two broken down motorcycles and they said they wouldn’t want to transport pregnant women on motorcycles even if they were working. That made sense to me. Or I should say it made sense for a brief moment. They went on to say that pregnant women usually come in to deliver on horseback or are carried in a chair or lying down on a door carried by their neighbors like pallbearers.

At that moment, I flashed back the advice I received at the labor and delivery class my wife and I had attended a few weeks ago in preparation for our son’s birth. “Partners,” she said, “watch out for potholes when you’re driving to the hospital. They are a killer when you’re pregnant.”

There are some things about working in Haiti (and the developing world in general), that are consistently frustrating.Visiting this hospital reminded me of two of them.

Nearly 100 doctors and over a thousand nurses get their degrees every year in Haiti. However, because they are paid so little by the government to work in public facilities, most do not remain for long. It is not uncommon for a doctor to make $500USD a month while a nurse can make between $250 and $350 depending on her level of training. And these are pre-tax salaries. Imagine a doctor making $6,000 a year. It’s insulting. Therefore, most of them either leave the country or work for NGOs in Haiti who pay them a decent wage. So while plenty of doctors and nurses are trained every year, many rural areas are left without a way to care for their people.

But I would say that by far the thing that makes you feel the worst, is that most of the things they are requesting can be provided with a relatively very small amount of money and yet they’ve been dealing with these problems for years. The doctor on the island of I’le a Vache asked if we could fix the leaky roof in his exam room so when it rained he and his patients wouldn’t get wet anymore. The doctor on the island of La Tortue needed $1,000 to dig a well so he could put running water in his hospital. The doctor in Petite Trou de Nippes said her dream would be to have an actual ambulance but she’d be happy if they could have some gurneys or stretchers so women wouldn’t have to be carried in on doors. The medical director of Beraca Hospital wants a sterilizer so they wouldn’t have to disinfect their instruments in a pot of boiling water on the stovetop anymore. The nurse on I’le a Vache needs a raise from $300 a month to $350 a month because her parents spent all their money to send her to school and now she’s responsible for taking care of her three siblings. And the administrator in Nippes, who was extremely proud to show me the professional patient records and filing system he keeps on all the patients who come in, said he needed a new desk because the one he’s using is just a piece of plywood sitting on top of two oil drums. For some reason, that one made me feel the worst. This guy was working for almost no pay (and often goes months without even getting a paycheck) yet was very proud of his work. The least you could do is give him a desk.

You could raise enough money from a bake sale to solve most of these problems. In fact, the Haitian doctor I was travelling with who had been working in the states for the last 30 years promised to personally pay the $1,000 for the well because of the thought of working in a hospital without running water was unbearable to him.

I take some comfort from the fact that I work for an organization that can help respond to most, if not all, of these requests. However at the same time I know we’re just scratching the surface. There are thousands of health facilities all over Haiti that need wells dug, leaky roofs fixed, and new desks for their administrators.

Friday, May 27, 2011

As I continue to travel around this country, I become more amazed and saddened that things actually seem to be more desperate once you leave Port au Prince. I came here to respond to the earthquake in Port au Prince but didn't imagine that things might actually be worse elsewhere.

Yesterday afternoon my colleagues and took the thirty minute flight from Port au Prince to Port de Paix in the far Northwest of the country. (A driver picked us up at the airport after driving up from the capital the day before and said it took him eight hours to get there due to the poor roads). We came to the north to visit two more hospitals in order to upgrade the conditions of their maternity wards and encourage more women to come to the hospital for pre-natal visits and delivery. As we drove down the long, bumpy and muddy road from the airport to the hospital I was struck by the fact that this town seemed to be the poorest I’d seen in Haiti. There were almost no other cars on the road (as compared to the constant traffic in Port au Prince) and the houses and roads looked to be in even worse shape than those in the capital. However, when we arrived at Beraca Hospital were greeted with a hot lunch of chicken, fish, plantains, rice and beans and a team of doctors and nurses who were eager to hear what we had come to offer.

Once again, I was struck by the eagerness and commitment of this medical staff to their jobs despite the fact that many of them had not been paid in months, their pharmacy had almost run out of stocks, and their sterilizer had broken so they had resorted to sterilizing their instruments in a pot of boiling water. This particular hospital had been funded by missionaries since it opened but funding has stopped and they haven’t received any outside support in over 10 years. Since they are not a government hospital, they do not receive any funding from the Ministry and thus have to rely on patient fees to support the hospital. That is almost unheard of in Haiti because it is simply not a model that can work here. Many patients cannot afford to pay for basic care. For example, ever since this hospital raised their fees for deliveries to 1,000GDS (roughly $25 USD), they only do 30 deliveries a month compared to the 100 they did before. So instead, the women have to deliver at home with the assistance of a matron who is often untrained and ill equipped to handle anything outside of a normal, perfectly smooth delivery.

This morning we left Port de Paix to head for La Tortue on a small boat with an outboard motor (that broke two times during the journey) and a purple velvet curtain attached to a PVC pipe that they used as a sail and boom. (The resourcefulness of Haitian people never ceases to amaze me).

When we reached the island of La Tortue I thought I might be at the end of the earth. This is an island of 40,000 people but only has 10 cars and a couple tiny boats to get supplies across. The steepness and bumpiness of the unpaved roads is astounding. A couple of times I thought for sure the Land Cruiser transporting us was going to tip over backwards due to the incline. And now, it’s 7pm and I’m sitting on the balcony of the only guesthouse in town overlooking the whole island that stretches nearly 50km long and 7km wide and there are no lights on as far as you can see in any direction. Indeed, the hospital we visited today only has power for 6 hours per day using a generator, does not have running water, and has to send patients to the hospital in Port de Paix (in that same velvet sail boat that takes nearly an hour—not to mention the trek to get to the water) if there is an emergency.

Today the doctor told us about a woman who came to deliver her baby at the hospital but he could not deliver the placenta no matter what he tried. So he sent her down the incredibly steep and bumpy road in the Land Cruiser and across the ocean in the velvet boat in order to be seen at the public hospital in Port de Paix. However, since this woman did not have the $30 for the procedure, they would not see her. So she waited outside the hospital for 4 days, meanwhile becoming infected, until finally her family was able to gather the money to get the hospital to perform the procedure.

This is an island where the hospital used to be the premier facility in the Caribbean and people traveled from all over the Caribbean to come for treatment. Today, I met the doctor at that same hospital on this same island and his first request was for a better boat so he could get patients away from his hospital and across the ocean to a different one.

This is an island where Napoleon’s sister once lived. Today, her house has been reduced to the foundation because the stones have been used to build dozens of other houses around the island by people who don’t have any other resources to use.

The sheer neglect of these areas over the past few decades has led to an astoundingly fast and extreme fall from decency.